The Effect of Clothing on Vitamin D Status, Bone Turnover Markers, and Bone Mineral Density in Young Kuwaiti Females

Abstract

Many Arab women in the Gulf region cover their bodies for cultural and religious reasons, limiting the skin’s exposure to sunlight and therefore its ability to synthesize vitamin D. The aim of this study is to determine whether the clothing style of Kuwaiti premenopausal women affects their vitamin D status, bone marker expression, and bone density. Three groups of healthy unmarried single Kuwaiti females (20-35 years old; n=30 per group) were recruited randomly from the general community: a control group who wear Western-style clothing (unveiled group), a group who wear a hejab that covers the whole body except for the face and hands (hejab group), and a group who wear a black veil with the entire body covered (veiled group). Bone mineral density (BMD), bone markers (procollagen type 1 N-terminal propeptide [P1NP], osteocalcin, and β-CrossLaps), 25-hydroxy vitamin D, intact parathyroid hormone [iPTH], and calcitonin were measured. The bone marker osteocalcin was significantly higher in the hejab group compared to the control group, whereas P1NP and β-CrossLaps were significantly higher in the veiled group compared to the control group. 25-hydroxy vitamin D, iPTH, calcitonin, and BMD were not significantly different across the three groups despite the observed elevation in bone turnover markers. The majority of participants in all three groups exhibited vitamin D deficiency; however, the lowest vitamin D levels were observed among the hejab and veiled participants. These findings suggest that clothing style may contribute to vitamin D deficiency in young Kuwaiti women.

Risk factors of multiple sclerosis in Aseer region, Kingdom of Saudi Arabia A case-control study

“…The full body covering practiced by females in many middle eastern countries may be related to the higher rate of vitamin D deficiency observed in these populations and may contribute to the higher rate of MS in female population and in those who report lower sun exposure in these populations. 32,33 Lower sun exposure could also be caused by is the reduced physical activity levels of Middle Eastern populations, consequent to lifestyle changes caused by the rise of industrialization and urbanization. 34 One of the important risk factors addressed in this study was cigarette smoking, which was twice as common among controls.…”

Physical Determinants of Vitamin D Photosynthesis: A Review

“…Vitamin D deficiency was found to be prevalent in Kuwaiti women wearing Western and traditional clothing but was more marked in the latter group. ( 157 ) Similarly, hijab‐wearing women in Nova‐Scotia (Canada) had less good vitamin D status than Western‐dressing counterparts. ( 158 ) Another factor to consider is physical activity, which may contribute to better vitamin D status independently of sunlight and dietary intake.…”

Vitamin D Metabolic Profiles in Premenopausal Women Wearing Niqab and Hijab in Sunny Basrah

“…Many studies adopted the lowest conservative ranges for vitamin D3, with a higher set point or physiologic adaptation of vitamin D, which may upregulate PTH [1,3,21,22]. Other studies also reported a non-significant relationship between vitamin D and PTH [7,11,18,23,24].…”

“…The prevalence of hypovitaminosis D is 1.6 to 1.7 times higher for women wearing a hijab and 1.9 to 2.7 times higher for women wearing a niqab than women in western dress styles [ 1 , 6 ]. Hypovitaminosis D carries a greater risk of osteoporosis [ 7 ].…”